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AimThe aim of this paper is to examine Canadian key informants’ perceptions of intrapersonal (within an individual) and interpersonal (among individuals) factors that influence successful primary care and public health collaboration.BackgroundPrimary health care systems can be strengthened by building stronger collaborations between primary care and public health. Although there is literature that explores interpersonal factors that can influence successful inter-organizational collaborations, a few of them have specifically explored primary care and public health collaboration. Furthermore, no papers were found that considered factors at the intrapersonal level. This paper aims to explore these gaps in a Canadian context.MethodsThis interpretative descriptive study involved key informants (service providers, managers, directors, and policy makers) who participated in one h telephone interviews to explore their perceptions of influences on successful primary care and public health collaboration. Transcripts were analyzed using NVivo 9.FindingsA total of 74 participants [from the provinces of British Columbia (n=20); Ontario (n=19); Nova Scotia (n=21), and representatives from other provinces or national organizations (n=14)] participated. Five interpersonal factors were found that influenced public health and primary care collaborations including: (1) trusting and inclusive relationships; (2) shared values, beliefs and attitudes; (3) role clarity; (4) effective communication; and (5) decision processes. There were two influencing factors found at the intrapersonal level: (1) personal qualities, skills and knowledge; and (2) personal values, beliefs, and attitudes. A few differences were found across the three core provinces involved. There were several complex interactions identified among all inter and intra personal influencing factors: One key factor – effective communication – interacted with all of them. Results support and extend our understanding of what influences successful primary care and public health collaboration at these levels and are important considerations in building and sustaining primary care and public health collaborations.

Background: Purposefully building stronger collaborations between primary care (PC) and public health (PH) is one approach to strengthening primary health care. The purpose of this paper is to report: 1) what systemic factors influence collaborations between PC and PH; and 2) how systemic factors interact and could influence collaboration. Methods: This interpretive descriptive study used purposive and snowball sampling to recruit and conduct interviews with PC and PH key informants in British Columbia (n = 20), Ontario (n = 19), and Nova Scotia (n = 21), Canada. Other participants (n = 14) were knowledgeable about collaborations and were located in various Canadian provinces or working at a national level. Data were organized into codes and thematic analysis was completed using NVivo. The frequency of “sources” (individual transcripts), “references” (quotes), and matrix queries were used to identify potential relationships between factors. Results: We conducted a total of 70 in-depth interviews with 74 participants working in either PC (n = 33) or PH (n = 32), both PC and PH (n = 7), or neither sector (n = 2). Participant roles included direct service providers (n = 17), senior program managers (n = 14), executive officers (n = 11), and middle managers (n = 10). Seven systemic factors for collaboration were identified: 1) health service structures that promote collaboration; 2) funding models and financial incentives supporting collaboration; 3) governmental and regulatory policies and mandates for collaboration; 4) power relations; 5) harmonized information and communication infrastructure; 6) targeted professional education; and 7) formal systems leaders as collaborative champions. Conclusions: Most themes were discussed with equal frequency between PC and PH. An assessment of the system level context (i.e., provincial and regional organization and funding of PC and PH, history of government in successful implementation of health care reform, etc) along with these seven system level factors could assist other jurisdictions in moving towards increased PC and PH collaboration. There was some variation in the importance of the themes across provinces. British Columbia participants more frequently discussed system structures that could promote collaboration, power relations, harmonized information and communication structures, formal systems leaders as collaboration champions and targeted professional education. Ontario participants most frequently discussed governmental and regulatory policies and mandates for collaboration.

In this article we report on qualitative findings that describe public health practitioners’ practice-based definitions of evidence-informed decision making (EIDM) and communities of practice (CoP), and how CoP could be a mechanism to enhance their capacity to practice EIDM. Our findings emerged from a qualitative descriptive analysis of group discussions and participant concept maps from two consensus-building workshops that were conducted with public health practitioners ( N = 90) in two provinces in eastern Canada. Participants recognized the importance of EIDM and the significance of integrating explicit and tacit evidence in the EIDM process, which was enhanced by CoP. Tacit knowledge, particularly from peers and personal experience, was the preferred source of knowledge, with informal peer interactions being the favored form of CoP to support EIDM. CoP helped practitioners build relationships and community capacity, share and create knowledge, and build professional confidence and critical inquiry. Participants described individual and organizational attributes that were needed to enable CoP and EIDM.

Aim The purpose of this scoping literature review was to determine what is known about: 1) structures and processes required to build successful collaborations between primary care (PC) and public health (PH); 2) outcomes of such collaborations; and 3) markers of their success. Background Collaboration between PC and PH is believed to enable more effective individual and population services than what might be achieved by either alone. Methods The study followed established methods for a scoping literature review and was guided by a framework that identifies systemic, organizational and interactional determinants for collaboration. The review was restricted to articles published between 1988 and 2008. Published quantitative and qualitative primary studies, evaluation research, systematic and other types of reviews, as well as descriptive accounts without an explicit research design, were included if they addressed either the structures or processes to build collaboration or the outcomes or markers of such collaboration, and were published in English. Findings The combined search strategy yielded 6125 articles of which 114 were included. Systemic-level factors influencing collaboration included: government involvement, policy and fit with local needs; funding and resource factors, power and control issues; and education and training. Lack of a common agenda; knowledge and resource limitations; leadership, management and accountability issues; geographic proximity of partners; and shared protocols, tools and information sharing were influential at the organizational level. Interpersonal factors included having a shared purpose; philosophy and beliefs; clear roles and positive relationships; and effective communication and decision-making strategies. Reported benefits of collaboration included: improved chronic disease management; communicable disease control; and maternal child health. More research is needed to explore the conditions and contexts in which collaboration between PC and PH makes most sense and potential gains outweigh the associated risks and costs.

In this paper we evaluate the use of appreciative inquiry in focus groups with public health nurses, managers and policy makers across Canada as part of our project to generate policy recommendations for building public health nursing capacity. The focus group protocol successfully involved participants in data collection and analysis through a unique combination of appreciative inquiry and nominal group process. This approach resulted in credible data for analysis, and the final analysis met scientific research standards. The evaluation revealed that our process was effective in engaging participants when their time available was limited, no matter what their position or public health setting, and in eliciting solution-focused results. By focusing on what works well in an organisation, appreciative inquiry enabled us to identify the positive attributes of organisations that best support public health nursing practice and to develop practical policy recommendations because they were based on participants’ experience. Further, appreciative inquiry was especially effective with public health policy makers and nurses as it is consistent with the strength-based, capacity building approaches inherent in public health nursing practice.

Optimal utilization of public health nurses (PHNs) is important for strengthening public health capacity and sustaining interest in public health nursing in the face of a global nursing shortage. To gain an insight into the organizational attributes that support PHNs to work effectively, 23 focus groups were held with PHNs, managers, and policymakers in diverse regions and urban and rural/remote settings across Canada. Participants identified attributes at all levels of the public health system: government and system-level action, local organizational culture of their employers, and supportive management practices. Effective leadership emerged as a strong message throughout all levels. Other organizational attributes included valuing and promoting public health nursing; having a shared vision, goals, and planning; building partnerships and collaboration; demonstrating flexibility and creativity; and supporting ongoing learning and knowledge sharing. The results of this study highlight opportunities for fostering organizational development and leadership in public health, influencing policies and programs to optimize public health nursing services and resources, and supporting PHNs to realize the full scope of their competencies.

This research examined leadership attributes that support the optimal utilization and practice of community health nurses (CHNs). Community health nursing is facing challenges in workforce capacity and sustainability. To meet current and future demands on the community sector, it is essential to understand workplace attributes that facilitate effective utilization of existing human resources and recruitment of new nurses. This pan-Canadian, mixed-methods study included a demographic analysis of CHNs in Canada, a survey involving responses from approximately 6,700 CHNs to identify enablers and barriers to community health nursing practice and 23 focus groups to examine organizational attributes that "best" support optimal practice within the public health nursing subsector. Nursing leadership was identified as an important attribute in organizations' utilization and support of CHNs working to work effectively. This effectiveness, in turn, will enhance community health programs and overall healthcare system efficiency. This paper highlights findings related to the role of nursing leadership and leadership development in optimizing community health nursing practice.

Objective: To report the population health surveillance functions of public health nurses and to describe factors that impede these functions. Design and Sample: An interpretive qualitative study was conducted in Public Health Service areas in Eastern Canada. Participants were public health nurses (n=55) with an average of 14.5 years of pertinent work experience. Measures: Semistructured face-to-face, telephone interviews, and focus groups were conducted, transcribed, coded, and analyzed. Results: The nurses in this study used ecosocial population health surveillance functions that included multilevel societal influences on health. Extensive interprofessional and intersectoral networks were foundational to their surveillance work, allowing them to monitor what was occurring in the community and transfer this knowledge into various systems to contribute toward improved health outcomes. However, the nurses did not acknowledge the significance of their population health surveillance work, and documentation structures did not support these surveillance functions. Conclusion: New surveillance methods and documentation structures that reflect an ecosocial surveillance approach are needed that are more consistent with public health nurses' population-focused practice.

OBJECTIFS: 1) Décrire l’effectif infirmier de santé communautaire au Canada; 2) Comparer, dans les compétences politiques et les secteurs de la santé communautaire, les éléments qui aident les infirmières et les infirmiers de santé communautaire à travailler de manière efficace ou qui les empêchent de le faire; 3) Définir les caractéristiques organisationnelles qui aident les membres d’un sous-secteur communautaire - infirmières et infirmiers de santé publique - à mettre en pratique la totalité de leurs compétences. MÉTHODES: Notre étude comprenait une analyse des bases de données de soins infirmiers de l’Institut canadien d’information sur la santé (1996-2007), une étude menée auprès de plus de 13 000 infirmières et infirmiers de santé communautaire au Canada et 23 groupes de discussion composés de décideurs en santé publique et d’infirmières et d’infirmiers de santé publique de première ligne. RÉSULTATS: En 2007, plus de 53 000 infirmières et infirmiers autorisés et infirmières et infirmiers auxiliaires autorisés travaillaient en santé communautaire au Canada, soit environ 16 p. 100 de l’ensemble de l’effectif infirmier. Les infirmières et les infirmiers de santé communautaire étaient en moyenne plus âgés que les autres de leur profession. Les infirmières et les infirmiers de santé communautaire travaillent habituellement dans les centres de santé communautaire, à domicile et dans les unités ou les services de santé publique. Pour effectuer leur travail de manière efficace, les infirmières et infirmiers de santé communautaire doivent avoir confiance en leurs compétences professionnelles, entretenir de bonnes relations en sein de leur équipe, travailler dans des milieux de travail favorables et obtenir le soutien communautaire. La plupart des infirmières et des infirmiers avaient confiance en leurs compétences et entretenaient de bonnes relations avec les autres infirmières et infirmiers ainsi que professionnels, quoique moins souvent avec les médecins. Ils avaient des opinions différentes relativement au salaire et à la sécurité d’emploi, et la plupart d’entre eux auraient aimé avoir plus de possibilités d’apprentissage, de renseignements sur les politiques et les pratiques ainsi que d’occasions de faire le bilan de leur travail. Ils désiraient que leur collectivité déploie de plus grands efforts pour s’occuper des déterminants sociaux de la santé et pour fournir des ressources de qualité. Certains facteurs doivent être réunis pour assurer la réussite des soins infirmiers de santé publique: une politique gouvernementale solide, une culture organisationnelle favorable et de bonnes pratiques de gestion. Parmi les caractéristiques organisationnelles considérées comme des mesures de soutien favorables à un travail optimal, soulignons la flexibilité du financement, de la conception des programmes et des descriptions de travail; une vision organisationnelle précise axée sur les valeurs partagées et les besoins communautaires; la planification coordonnée de la santé publique entre les compétences; une direction solide qui fait ouvertement la promotion de la santé publique, qui attache de l’importance au travail du personnel et qui investit dans l’éducation et la formation. Conclusion: L’utilisation interchangeable et non uniforme des titres des infirmières et des infirmiers de santé communautaire et de leurs employeurs fait en sorte qu’il est difficile de discerner les différences au sein de ce secteur, comme les soins à domicile, la santé publique, etc. Nos études ont également permis de constater que les infirmières et les infirmiers de santé communautaire: travaillent dans des milieux où ils partagent la vision et les buts de leur organisme et travaillent en collaboration dans une ambiance qui incite à l’action et qui favorise l’autonomie; travaillent bien ensemble, mais ont besoin de temps, de financement flexible et de soutien de la part de la direction pour créer des liens avec la collectivité et leurs clients, et pour former des équipes avec d’autres professionnels; pourraient maintenir leurs compétences et leur confiance en leurs aptitudes professionnelles en ayant davantage accès à de la formation continue, aux politiques, aux données probantes et aux séances de bilan. REMERCIEMENTS: Nous désirons remercier les membres de notre équipe de recherche pour avoir guidé les activités de l’étude. D(r) David Butler-Jones, administrateur en chef de la santé publique du Canada; Audrey Laporte, Université de Toronto; Sandra MacDonald-Rencz, directrice générale, Bureau de la politique des soins infirmiers, Santé Canada; Barbara Oke, retraitée, directrice générale, Bureau des services de soins infirmiers, Direction générale de la santé des Premières nations et des Inuits; Susan Matthews, Système de santé de Niagara; Lynnette Leeseberg Stamler, Association canadienne des écoles de sciences infirmières; Rosemarie Goodyear Association canadienne des infirmières et infirmiers en santé communautaire; D(r) Cory Neudorf et D(r) Steven Whitehead, région sanitaire de Saskatoon; Paul Fisher et Chris Bailey, Conseil canadien de réglementation des soins infirmiers auxiliaires; Ron Wall, Agence de la santé publique du Canada; D(r) John Blatherwick, retraité, Vancouver Coastal Health; Lynn Jobin, Direction générale de la santé publique du Québec; Valerie St. John, Ministry of Health Services de la Colombie-Britannique. Nous remercions les personnes suivantes, qui ont contribué à la préparation du présent rapport: Suzanne Ross, consultante en politique de santé; Maureen Best, Mount Royal College; Penny Nelligan, consultante en santé publique; Mary Crea et Alina Dragan, coordonnatrices de la recherche; Rebecca Ganann, étudiante au doctorat. Les organismes suivants ont financé la présente recherche: Fondation canadienne de recherche sur les services de santé; Agence de la santé publique du Canada; Santé Canada (Division des stratégies en matière de ressources humaines en santé; Bureau de la politique des soins infirmiers; Direction générale de la santé des Premières nations et des Inuits); Ministry of Health Services de la Colombie-Britannique (Nursing Directorate; Communicable Diseases and Addictions Prevention Branch); Université McMaster, Nursing Health Services Research Unit; Vancouver Coastal Health. La reconnaissance de la contribution financière de ces organismes ne sous-entend pas l’approbation des résultats ou de l’analyse.

Citizen participation is heralded as a critical element of community health programs that emphasize empowerment and health promotion strategies. Although there is a growing body of research on public health nurses' primary health care practice, few studies have described how public health nurses foster citizen participation. This article presents findings from an interpretive qualitative study of public health nurses' perceptions of their role in fostering citizen participation in an eastern Canadian province at a time of significant health care restructuring. The findings from this study clearly profile public health nurses as integral to the practice of fostering citizen participation.

Purpose. This paper examines baccalaureate nursing students’ beliefs about the relationship between poverty and health, and the factors that influence these beliefs. Background. The relationship between poverty and health is well established, and poverty remains a persistent problem in many industrialized nations. Nurses’ understanding of how poverty influences health will affect how they interact with individual clients as well as the strategies they employ to address poverty-related issues. No studies have examined nursing students’ understandings of how poverty influences health and the factors that influence that understanding. Methods. A cross-sectional survey of a random sample (n = 740) of basic baccalaureate nursing students was conducted in three Canadian universities in 2000. Students completed a 59-item questionnaire eliciting data on demographic variables, personal and educational exposure to poverty, beliefs about the relationship between poverty and health (myth, drift, behavioural, structural), and attitudes to poverty. Results. Students were most likely to adhere to a structural explanation of the relationship between poverty and health. Very little of the variance in myth and drift explanations was accounted for by course or personal exposure, programme level, age, and attitudes toward poverty. Greater course exposure and more positive attitudes toward the poor predicted support for the structural explanation. Support for the behavioural explanation was influenced by attitudes toward the poor and, to a lesser extent, by course exposure, age, and programme level. Conclusion. Students would benefit from greater exposure to poverty through coursework that emphasizes the structural factors contributing to poverty and its negative health consequences. Classroom experience should be complemented with clinical placements that provide students with opportunities to interact with families living in poverty and to work collaboratively with others to address the causes and consequences of poverty at community and policy levels.

Given the link between poverty and health, nurses, in their work in hospitals and in the community, often come into contact with people who are poor. To be effective care providers, nurses must have an adequate understanding of poverty and a positive attitude toward people who are poor. This study examined attitudes toward poverty among baccalaureate nursing students ( N = 740) at three Canadian universities. Students’ attitudes were neutral to slightly positive. Personal experiences appeared to have an important influence on the development of favorable attitudes. The findings point to several considerations for nursing curricula. Students should not only be provided with classroom opportunities for critical exploration of poverty and its negative effects on individuals and society, but also have clinical learning experiences that bring them face-to-face with people who are poor, their health concerns, and the realities of their circumstances. Thoughtful critique of poverty-related issues and interpersonal contact may be effective strategies to foster attitude change.

Mothers’ ability to provide healthy food choices for their children has become more complex in our current obesogenic environment. We conducted a total of 35 interviews with 18 mothers of preschool children. Using constructivist grounded theory methods, we developed a substantive theory of how mothers make food choices for their preschoolers. Our substantive theory, persistent optimizing, consists of three main integrated conceptual categories: (a) acknowledging contextual constraints, (b) stretching boundaries, and (c) strategic positioning. Implications to improve mothers’ ability to make healthy food choices that reduce their children’s risk of becoming overweight or obese are discussed.

Rapidly increasing enrollment in Canadian schools of nursing has triggered the development of innovative clinical placement sites. There are both opportunities and challenges inherent in the delivery of clinical nursing education in diverse community settings. As part of the Canadian Association of Schools of Nursing’s (CASN) ongoing work to assist its members and ensure baccalaureate graduates are prepared to meet the Canadian Community Health Nursing Standards of Practice at an entry-to-practice level, the CASN Sub-Committee on Public Health (funded by the Public Health Agency of Canada) conducted extensive national consultations with representatives from both academic and practice settings, as well as key national organizations. The resultant Guidelines for Quality Community Health Nursing Clinical Placements, released by CASN in 2010, aim to provide direction to Canadian schools of nursing and practice settings in addressing the challenges and opportunities arising from the changing context of community health nursing student clinical placements.

This paper describes the methods, strategies and technologies used to conduct a scoping literature review examining primary care (PC) and public health (PH) collaboration. It presents challenges encountered as well as recommendations and 'lessons learned' from conducting the review with a large geographically distributed team comprised of researchers and decision-makers using an integrated knowledge translation approach.Scoping studies comprehensively map literature in a specific area guided by general research questions. This methodology is especially useful in researching complex topics. Thus, their popularity is growing. Stakeholder consultations are an important strategy to enhance study results. Therefore, information about how best to involve stakeholders throughout the process is necessary to improve quality and uptake of reviews.This review followed Arksey and O'Malley's five stages: identifying research questions; identifying relevant studies; study selection; charting the data; and collating, summarizing and reporting results. Technological tools and strategies included: citation management software (Reference Manager®), qualitative data analysis software (NVivo 8), web conferencing (Elluminate Live!) and a PH portal (eHealthOntario), teleconferences, email and face-to-face meetings.Of 6125 papers identified, 114 were retained as relevant. Most papers originated in the United Kingdom (38%), the United States (34%) and Canada (19%). Of 80 papers that reported on specific collaborations, most were descriptive reports (51.3%). Research studies represented 34 papers: 31% were program evaluations, 9% were literature reviews and 9% were discussion papers. Key strategies to ensure rigor in conducting a scoping literature review while engaging a large geographically dispersed team are presented for each stage. The use of enabling technologies was essential to managing the process. Leadership in championing the use of technologies and a clear governance structure were necessary for their successful uptake.

The sport of curling is an important activity in rural Canada, with many female participants. The health of women in rural Canada is much compromised compared to that of their urban counterparts, yet little research has explored ways to promote the health of rural women. This study examined the influence of curling on the health of women in rural Canada. A sample of 15 women and girls aged 12 to 72 from 2 communities in southwestern Ontario took pictures, kept logbooks, and participated in 2 group sessions to discuss the influence of curling on their health. The findings reveal that curling facilitates social connections, enhances physical and mental health, and provides a valued and visible way to support rural life. Clearly, curling promotes the health and community life of rural women in significant ways. More support for curling in rural settings is needed, and additional research on the topic of curling and the health of rural women is indicated.

Optimal utilization of public health nurses (PHNs) is important for strengthening public health capacity and sustaining interest in public health nursing in the face of a global nursing shortage. To gain an insight into the organizational attributes that support PHNs to work effectively, 23 focus groups were held with PHNs, managers, and policymakers in diverse regions and urban and rural/remote settings across Canada. Participants identified attributes at all levels of the public health system: government and system-level action, local organizational culture of their employers, and supportive management practices. Effective leadership emerged as a strong message throughout all levels. Other organizational attributes included valuing and promoting public health nursing; having a shared vision, goals, and planning; building partnerships and collaboration; demonstrating flexibility and creativity; and supporting ongoing learning and knowledge sharing. The results of this study highlight opportunities for fostering organizational development and leadership in public health, influencing policies and programs to optimize public health nursing services and resources, and supporting PHNs to realize the full scope of their competencies.

Keywords: community development; primary health care; public health nursing; leadership; management

To report the population health surveillance functions of public health nurses and to describe factors that impede these functions.An interpretive qualitative study was conducted in Public Health Service areas in Eastern Canada. Participants were public health nurses (n=55) with an average of 14.5 years of pertinent work experience.Semistructured face-to-face, telephone interviews, and focus groups were conducted, transcribed, coded, and analyzed.The nurses in this study used ecosocial population health surveillance functions that included multilevel societal influences on health. Extensive interprofessional and intersectoral networks were foundational to their surveillance work, allowing them to monitor what was occurring in the community and transfer this knowledge into various systems to contribute toward improved health outcomes. However, the nurses did not acknowledge the significance of their population health surveillance work, and documentation structures did not support these surveillance functions.New surveillance methods and documentation structures that reflect an ecosocial surveillance approach are needed that are more consistent with public health nurses' population-focused practice.

The Canadian Schools of Nursing (CASN) task force on public health was mandated to facilitate Schools of Nursing to provide students with the foundation required to meet the Canadian Community Health Nursing Standards of Practice. This paper reports on an environmental scan that explored barriers and enablers influencing the integration of community health nursing content in baccalaureate education in Canada. Data was collected over three phases including: 1) a pan-Canadian survey of nursing schools, 2) completion of open-ended workbook questions by educators, policy makers, administrators, and community health nursing managers attending a pan-Canadian symposium on community health nursing, and 3) recorded notes from the symposium. The response rate for the survey was 72.5% (n = 61 schools) and approximately 125 stakeholders participated in symposium activities. Internal and external enablers and challenges as well as recommendations for practice and education are presented.

To examine how empowerment, as an ideology and a practice of teaching and learning, was understood and applied by public health nurses (PHNs) in health education with child bearing and child rearing families.Feminist poststructuralism was used to guide data collection and analysis. In-depth, individual interviews were conducted with three mothers and three PHNs and explored the different perspectives held by mothers and PHNs during a home visit.Moments of conflict, contradiction, affirmation, and agreement highlighted various empowering relations. Individual choice and recognition of knowledge and power exemplified how both mothers and PHNs used their "agency" to position themselves into a particular relationship. The analysis includes five sections: (a) mother's perceptions of PHNs, (b) normalization as problematic: the good/bad dichotomy, (c) professional/expert: the balance of power, (d) working the relationship, and (e) reflections on empowerment.The information gathered from this studyprovides a rich understanding of the nurses' educational practices with new mothers.

Current literature indicates that women, and society in general, do not see coronary heart disease (CHD) as a serious concern for women. This lack of recognition seems, in part, to be related to a lack of research involving women as participants and in developing nursing knowledge specific to women and CHD. Although existing literature provides valuable insight into cardiac recovery, it does not clearly explore women's perceptions of their experiences in the early home convalescent recovery process following a myocardial infarction (MI). This study reports on the supportive-educative experiences of eight English speaking women, ages 33-61, in their early recovery process following an MI. Inductively generated data analysis has provided a means to understand the process of recovery from the perspective of these participants. Inherent in the participants' words, as they discussed their journeys with recovery, was an overwhelming sense of uncertainty while living with heart disease. For these women, their socially constructed knowledge dictated that women, and in particular, young women, did not experience heart attacks, and was, therefore, in conflict with their realities. The contradiction between the 'truths learned from others' and their MI experiences influenced, and was influenced by, the subsequent emerging themes of a 'rude awakening,' 'disconnected knowing,' and 'reconnecting self.' Feminist research challenges tradition and offers nursing an opportunity to explore and investigate issues of importance to our profession in a different way. Nurses, as well as other health care professionals, need to be aware of the social construction of cardiac illness and women's experiences, as this knowledge has great implications for patient care from prevention to rehabilitation within the cardiac experience. Based on the results of this study, implications for nursing education, research and practice are discussed.

An interpretive qualitative study was conducted to examine public health nurses' (PHNs') practice in fostering citizen participation and collaborative practice and the impact of a decade (1992–2002) of health care restructuring. This article presents the perspectives of public health management and a public policy analysis as they relate to PHNs' primary health care practice in Nova Scotia, a province in Eastern Canada. Seven face-to-face interviews were conducted with public health management from across Nova Scotia and 26 relevant public policy documents were analyzed. Three major themes emerged from the coded transcripts and the document analysis: (1) opportunistic shifts in values: constraining structures, operations, and governance; (2) insufficient funding and infrastructure support; (3) opportunities and challenges to PHN capacity and competency. The emergent themes illustrate the unique population health perspective and day-to-day contested realities of public health and PHN practice. The study provides preliminary understanding of PHNs' primary health care practice in Nova Scotia that may resonate with other national and international settings. This knowledge can form a basis for more research to explore the PHNs' practice in the organizational context in which it is embedded. This study was undertaken at a pivotal time in Nova Scotia as the provincial government embarked on primary health care renewal to improve the health of Nova Scotians. The success of this study is in large part attributable to the collaborative effort of university researchers and public health decision makers.

(1997) BMJ 315, 396. Rich-Edwards JW, Stampfer MJ, Manson JE . , et al. . Birth weight and risk of cardiovascular disease in a cohort of women followed up since 1976. . Aug 16; . : . –400. . [OpenUrl][1][Abstract/FREE Full Text][2] To determine if an association exists between birth weight and non-fatal cardiovascular disease in women who were nurses. Cohort study of women in the Nurses' Health Study followed up every 2 years from 1976 to 1992. USA. 70 297 women (mean age 42 y in 1976) born between 1921 and 1946, all registered nurses, who were free from coronary heart disease and stroke in 1976. Women were grouped by their birth weight category: 2495–3175 g (n=21 171), >3175–3856 g (n=31 216), >3856–4536 g (n=7723), or >4536 g (n=1638). 3608 women who were born prematurely were not included in the analysis. Postal questionnaires were used to gather data on past and current cardiovascular disease risk factors in 1976 and birth weight in 1992. Data on non-fatal myocardial infarction (symptoms and either electrocardiographic changes or increased cardiac enzyme concentrations), coronary revascularisation (coronary artery bypass grafting or angioplasty), and non-fatal stroke (evidence of a typical neurological … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DRich-Edwards%26rft.auinit1%253DJ.%2BW%26rft.volume%253D315%26rft.issue%253D7105%26rft.spage%253D396%26rft.epage%253D400%26rft.atitle%253DBirth%2Bweight%2Band%2Brisk%2Bof%2Bcardiovascular%2Bdisease%2Bin%2Ba%2Bcohort%2Bof%2Bwomen%2Bfollowed%2Bup%2Bsince%2B1976%26rft_id%253Dinfo%253Apmid%252F9277603%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=315/7105/396&atom=%2Febnurs%2F1%2F2%2F57.atom